AIDS Commission takes new direction in prevention

The Uganda AIDS Commission (UAC) is revamping its national HIV information campaign after HIV prevention messages were less successful than hoped.

"We shall use basic facts in the messages to communicate effectively because we have realized that the level of knowledge about basic facts on HIV information is quite limited," said Saul Onyango, senior health educationist with the UAC.

The term high-risk sex - previously defined as sex with an irregular partner - is to be redefined as sex with anyone whose HIV status is not known. As such, the term “most at-risk populations” will no longer refer to specific groups such as sex workers, fishing communities and men who have sex with men, but to all members of the population engaging in risky sex.

Campaigns aimed at ending cross-generational sex will be abandoned in favour of generic warnings about engaging in risky sex because of fears that young people may believe that sex within their own generation is risk-free. Officials have also said factors such as alcohol abuse, which predispose people to risky sexual behaviour, must be tackled alongside HIV prevention.

The commission has assembled a team of medical and communication experts to develop the new messages, and will work with English and local language media to disseminate them.

"We have to change the destiny of this country, even if it means putting back the drums of the 1980s that used to frighten people," said UAC director-general, David Kihumuro Apuuli.

An ominous drumbeat, followed by a booming voice warning that "AIDS kills", was the centre of a radio HIV prevention campaign when Uganda first began its fight against HIV in the late 1980s. Several senior officials - including Jesse Kagimba, senior presidential adviser on HIV/AIDS - have called for the return of fear-driven campaigns, which they say were instrumental in Uganda's initial success in lowering prevalence.

However, detractors of this method say the key to success in prevention is education, not fear. Some studies show that scare tactics alone do not lead to behaviour change, but rather encourage denialism and fatalism. Experts also say that such campaigns promote stigma and discrimination, and that in the age of widely available life-prolonging antiretroviral medication, they could prove ineffective.

We need to change the mentality and behaviour of men; they have multiple sexual partnerships called side-dishes, which is creating a web

After successfully bringing prevalence down from more than 20 percent in the 1980s to about 6 percent by 2000, Uganda's HIV levels have stagnated, showing a marginal increase in prevalence over the past few years.

Tailored response

The new messages will attempt to bring the HIV response in line with the drivers of the epidemic. According to a recent study, 37 percent of new Ugandan HIV infections are attributable to multiple partnerships, 35 percent occur within discordant monogamous couples, 18 percent are due to mother-to-child transmission, and 9 percent occur through commercial sex networks.

"We need to change the mentality and behaviour of men; they have multiple sexual partnerships called side-dishes, which is creating a web," Kihumuro said. "Before we know it the whole of Kampala [the capital] will be entangled into one web."

According to the UAC, there are 110,000 new HIV infections annually and 63,000 deaths from HIV-related illnesses.

The study found that although Uganda had made good progress in rolling out key HIV prevention services, the campaigns had not reached all sections of the population.

"Over three-quarters of all adults, including many people living with HIV, do not know their HIV sero-status; services for PMTCT currently reach less than half of pregnant women," it found. "Although condom use has increased, its coverage has not yet reached the critical levels necessary for it to impact on population level HIV transmission."

Kihumuro noted that there was an urgent need for the government to commit more resources to the fight against HIV/AIDS. At present, the government funds about 6 percent of the national HIV response.

"A lot of the money coming in is from donors; we cannot sustain this," he added.